Director, Member Org Integration (MOI) - Portland, Maine

Company: Optum
Location: Portland
Posted on: April 5, 2025

Job Description:

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Reporting to the VP of Revenue Cycle of the NLH segment, this position is responsible for providing leadership for all activities related to the management of NLH's Revenue Cycle Integration (RCI) function. The Director of Revenue Cycle Member Organization Integration (RCI) is responsible for providing coordination, direction, and leadership to achieve ongoing operational quality, productivity, and efficiency between enterprise revenue cycle services and NLH Member Organization facilities and physician practices. This position serves as the liaison between enterprise revenue cycle services and Member Organization leadership, management, and staff.

If you are located in Maine, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Participate on revenue cycle leadership team meetings providing insights and communicating key operational and financial decisions pertaining to the revenue cycle
• Build effective and collaborative work relationships and facilitate productive communication between key revenue cycle stakeholders, including peer leaders of revenue cycle services and other core support departments (e.g., human resources, finance)
• Create a work environment for employees through team building, coaching, constructive feedback, work delegation, personal example, and goal setting that encourages creativity, open dialogue on work issues, professional growth, and a consistent, high level of performance
• Encourage and support employee decision-making within their scope of responsibilities
• Set and maintain standards for the interaction between NLH Member Organizations and the Enterprise Revenue Cycle Team
• Oversee the performance and operations of the RCI function, and act as the primary liaison between Enterprise Revenue Cycle functions and Member Organization operations
• Develop a deep understanding of all NLH Member Organization's Revenue Cycle operations, which includes a thorough understanding of Cerner and any applicable systems and tools
• Build solid relationships and facilitate effective communication between hospital and physician-based Revenue Cycle and Clinical (where appropriate) operations, centralized
• Revenue Cycle operations (PAS, Middle Revenue Cycle Operations, PFS, Customer Service), and core support departments (e.g., human resources, business support services, compliance, finance)
• Address business needs upon identification; conduct regular meetings with Member Organization VPs of Finance and other key leadership; provide analysis and context for monthly performance data
• Facilitate the management (i.e. development of action plans) and resolution of escalated issues that arise and impact both Member Organization and centralized Revenue Cycle operations
• Analyze and report on Key Performance Indicator (KPI) data and coordinate Revenue Cycle analytics, utilizing all available data
• Provides strategic guidance and direction on key Member Organization Revenue Cycle-specific operational and financial decisions; lead NLH Revenue Cycle and departmental committees and meetings designed to improve Revenue Cycle operations/processes and financial performance, as necessary
• Develop, maintain, and monitor service level agreements (SLAs) between hospital and physician-based Revenue Cycle operations (Patient Access, onsite HIM Operations) and other related functions, within both Revenue Cycle and Clinical operations as necessary
• Develop and present information to Member Organization leadership on all aspects of the Revenue Cycle
• Oversee training of Member Organization resources on functions within the Revenue Cycle, as needed
• Participate in and, where appropriate, lead cross functional Revenue Cycle projects
• Create a work environment for employees through team building, coaching, constructive feedback, work delegation, personal example, and goal setting that encourages creativity, open dialogue on work issues, professional growth, and a consistent, high level of performance
• Encourage and support employee decision-making within their scope of responsibilities
• Identify opportunities for revenue improvement, automation, or issue resolution. Creates and provides data to baseline and drive solution outcomes
• Analyze operational requirements and system capabilities
• Facilitate all levels of management for developing and implementing key strategies in integration, quality, process efficiency, and performance outcomes
• Maintain up-to-date clinical knowledge and applies that knowledge in the development of future state processes, as well as, in the analysis of current state processes
• Participate in and conduct internal and/or external meetings and training programs while staying current and compliant on key regulatory and/or statutory issues that may affect current/future assignments
• Inform leadership of these issues and of any related impacts to the Revenue Cycle team, and others as applicable
• Complete any duties and special assignments, as requested Budget Responsibility
  • Administer expense budget for department
  • Present departmental budget recommendations to VP of Revenue Cycle for approval
  • Monitor budget performance and variance explanations
  • Optimize vendor relationships as necessary
  • Evaluate current and new technology solutions Authority / Decision Making Level
    • Prioritize and organizes work within division to meet changing priorities Leadership
      • Evaluate, monitor, and assist in developing the priorities and progress of the Revenue Cycle Department
      • Provide senior leadership with information regarding receivable and/or departmental performance
      • Assist in implementing improvements in work process that both improve the efficiency and effectiveness of the revenue cycle
      • Lead redesign initiatives and other sponsored initiatives as requested
      • Design easily understood and impactful managerial reports for wide distribution
      • Monitor payer and vendor activities and communications
      • Stress attention to detail and designs monitoring tools to ensure accuracy
      • Identify opportunities for improved efficiency through better processes and additional automation
      • Coordinate and collaborate with key revenue cycle functions to ensure strategic alignment with broader organizational goals and objectives
      • Function effectively in a Matrix Management environment People
        • Demonstrate leadership and commitment to colleagues by accepting accountability for outcomes, sharing timely information, building effective relationships and communicating clearly and directly
        • Ensure adequate training is being provided to staff to educate on the following skills: current working knowledge of payer requirements; sufficient healthcare knowledge necessary to perform job requirements; knowledge of state, local and federal policy requirements for functions performed; and relevant knowledge of information technologies
        • Lead and coordinate ongoing staff evaluation, retention, training and management of policies and procedures
        • Oversee and ensure two-way communication with Member Organization leadership and Revenue Cycle leadership Process
          • Develop, implement, and manage efficient and effective operational policies, processes and performance monitoring across all functions of the Revenue Cycle Department
          • Provide ongoing feedback loop communication to other Revenue Cycle areas
          • Develop, implement, and manage efficient and effective operational policies, processes and performance monitoring across all Revenue Cycle functions
          • Coordinate payer trend analysis to ensure optimal processing and reimbursement, identify issues, communicate findings to Revenue Cycle stakeholders, define solutions and initiate resolution Performance Monitoring
            • Measure and report ongoing financial and operational performance of the Revenue Cycle department
            • Recognize areas of excellence and oversee the development and implement action plans related to functional areas where performance is not meeting expectations
            • Manage/communicate the department dashboard and design action plans as issues are identified within the unit
            • Ensure that key performance metrics are met on a monthly basis You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
              
              Required Qualifications:
              • 6+ years of experience in Revenue Cycle or related Business Support Services or equivalent within a large health system, with at least three of those years in a management capacity
              • Work experience in a leadership role in a redesign project . click apply for full job detailsby Jobble

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